Nitroglycerin and DASI Quiz

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Questions and Answers

What is the required action regarding the medical history before treating a patient?

It can be updated only after the treatment is finished.

It should only be documented once at the first visit.

It should be ignored if it seems irrelevant.

It must be completed and/or reviewed at the start of treatment. (correct)

Which ASA classification is appropriate for a patient requiring treatment in a hospital setting?

ASA I

ASA IV (correct)

ASA III

ASA II

What blood pressure reading is defined as hypertension?

Equal to or greater than 130/80 (correct)

Between 120/80 and 129/89

Lower than 120/80

Only when experiencing symptoms

How often should a patient's medical history be updated?

At the start of treatment and regularly thereafter Signup and view all the answers

What percentage of the population approximately suffers from hypertension?

Approximately 1 in 4 people Signup and view all the answers

What defines a hypertensive emergency?

Severe elevation in BP with evidence of organ dysfunction Signup and view all the answers

Which of the following is considered a major risk factor for cardiovascular disease?

Unstable coronary syndromes Signup and view all the answers

Which intervention should be considered to mitigate hypertensive urgencies in patients?

Oral sedation and stress reduction Signup and view all the answers

Which statement about antihypertensives is true?

Diuretics and CCBs are part of antihypertensive options. Signup and view all the answers

What is a characteristic of hypertensive urgency?

Sustained blood pressure of 180/110 mmHg or higher Signup and view all the answers

Which of the following is a minor risk factor for cardiovascular complications?

Advanced age over 70 years Signup and view all the answers

What should be monitored during procedures on hypertensive patients?

Blood pressure and possible complications Signup and view all the answers

Which treatment should be avoided in patients with severe hypertension?

Prolonged use of NSAIDs Signup and view all the answers

What is the classic cause of infective endocarditis characterized by infection of the heart valves?

Streptococcal bacteria Signup and view all the answers

Which of the following best describes the Duke Activity Status Index (DASI)?

A questionnaire to measure self-reported physical work capacity Signup and view all the answers

Which is a risk associated with untreated heart failure?

Higher risk of arrhythmias and sudden death Signup and view all the answers

What is one of the peripheral manifestations of infective endocarditis?

Clubbing of the digits Signup and view all the answers

Which situation necessitates antibiotic prophylaxis for patients regarding infective endocarditis?

Cardiac transplantation recipients with valvulopathy Signup and view all the answers

What does a score in the Duke Activity Status Index indicate?

Higher functional capacity Signup and view all the answers

What is the mortality rate for infective endocarditis in the US?

40% Signup and view all the answers

Which of the following is a causative microorganism for infective endocarditis?

Staphylococcus aureus Signup and view all the answers

Which valve condition classifies as native valve endocarditis?

Infection of a natural heart valve Signup and view all the answers

Which of the following patients is at an increased risk for infective endocarditis?

Individuals with IVDU history Signup and view all the answers

Study Notes

Nitroglycerin (GTN) Administration

Dosage: 0.3 to 0.4 mg sublingually (SL) or as a spray, up to two doses at 3 to 5-minute intervals.
Contraindications include low systolic blood pressure (SBP) and orthostatic hypotension awareness.
Use caution with antiplatelets or anticoagulants; patients may also be on Digoxin.
Avoid benzodiazepines due to possible increased Digoxin serum levels.
Excessive vasoconstrictor use may trigger arrhythmias.
Untreated symptomatic heart failure raises risks of myocardial infarction (MI), arrhythmias, acute heart failure, or sudden death.

Duke Activity Status Index (DASI)

A 12-item survey to assess self-reported physical work capacity estimating peak metabolic equivalents (METs).
Higher scores indicate better functional capacity compared to NYHA classification.
1 MET equates to 1 kcal/kg/hr or 3.5 ml/kg/min oxygen consumption at rest.

Infective Endocarditis

Caused by microbial infections of heart endothelial surfaces or valves, with a US mortality rate of 40%.
Classifications include:
- By microorganism: Streptococcal, Staphylococcal, Candida.
- By valve type: Native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE).
- By infection source: Community-acquired, hospital-acquired, intravenous drug use (IVDU).
Prevention is emphasized due to treatment difficulties.

Signs and Symptoms of Infective Endocarditis

Common symptoms include fever, heart murmur, and positive blood cultures.
Rare peripheral manifestations:
- Osler’s nodes (subcutaneous nodules)
- Janeway lesions (petechiae)
- Splinter hemorrhages (nail bed)
- Roth spots (retinal hemorrhages)
- Splenomegaly and digital clubbing.

American Heart Association (AHA) Guidelines

Considerations for prophylactic antibiotics include:
- Presence of prosthetic heart valves or materials for valve repair.
- History of infective endocarditis.
- Specific congenital heart diseases and those repaired within 6 months involving prosthetic material.

Hypertensive Conditions

Hypertensive Urgency: Blood pressure ≥180/≥110 mmHg with minimal or no symptoms.
Hypertensive Emergency: Severe blood pressure elevation with signs of target organ dysfunction, such as encephalopathy or acute MI.
Recommendations include identifying hypertension, medication management, and intraoperative monitoring.
Antihypertensive medications: diuretics, beta blockers, ACE inhibitors, ARBs, CCBs; monitor for orthostatic hypotension and avoid prolonged NSAID use.

Cardiovascular Risk Factors

Major risks: unstable coronary syndromes, decompensated heart failure, severe arrhythmias, and significant valvular disease.
Intermediate risks: history of ischemic heart disease (IHD), compensated heart failure, cerebrovascular issues, diabetes, renal insufficiency.
Minor risks: age >70, abnormal ECGs, and uncontrolled systemic hypertension.

Medical History Considerations

Essential for assessing systemic diseases before treatments and procedures.
Ensure thorough medical history review at the start of treatment and maintain regular updates.

Hypertension Overview

Defined by sustained pressures ≥130/80 mmHg; affects approximately 1 in 4 people.
Many individuals remain asymptomatic initially but may eventually develop organ damage to the kidneys, heart, brain, and eyes.

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Description

Test your knowledge on Nitroglycerin (GTN) administration, including dosage guidelines and contraindications. Additionally, explore the Duke Activity Status Index (DASI) and its relevance in assessing physical capacity. This quiz covers essential aspects of cardiac care and patient management.